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NPI Code Detail

MEDICARE: RANDI PORCENALUK LMFT

MEDICARE: RANDI PORCENALUK LMFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1172V00000XCommunity Health Worker
2106H00000XMarriage & Family Therapist
3171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1811675051
Entity Type Code : Individual
Provider Name (Legal Business Name) : RANDI PORCENALUK LMFT
Provider Business Mailing Address
First Line : 4522 FULTON DR NW
Second Line :
City : CANTON
State : OH
Zip : 44718-2332
Country : US
Telephone Number : 330-915-2907
Fax Number : 330-915-2958
Provider Business Practice Location Address
First Line : 5611 HUDSON DR STE 400
Second Line :
City : HUDSON
State : OH
Zip : 44236-4452
Country : US
Telephone Number : 330-915-2907
Fax Number : 330-915-2907
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2023
Last Update Date : 05/12/2026

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Directions to “ RANDI PORCENALUK LMFT” Practice Location

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